Transaxillary minimally invasive valve surgery had similar 30-day survival (91.8% vs. 85.2%) and 3-year survival (89.1% vs. 73.9%) as sternotomy, with shorter ICU stay.
Does minimally invasive valve surgery via transaxillary access provide comparable survival and safety to full sternotomy in patients with native valve endocarditis?
In selected patients with native left-sided infective endocarditis, minimally invasive valve surgery via transaxillary access is safe, yields comparable survival to full sternotomy, and significantly reduces ICU length of stay.
Objectives Minimally invasive surgery for endocarditis reflects an emerging advancement in surgical therapy. Transaxillary access is a novel approach, with little current data on its safety and efficacy in these patients. This study reports outcomes of a transaxillary access cohort in aortic and mitral endocarditis compared to a full‐sternotomy cohort. Methods All consecutive patients undergoing surgery for native infective endocarditis from 2021 to 2024 at our facility were enrolled. Exclusion criteria were redo procedures, right‐sided endocarditis, and concomitant bypass surgery. The patients fulfilling the inclusion criteria ( n = 179/316; 56.7%) were divided into a transaxillary cohort ( n = 81) and a sternotomy cohort ( n = 98). After 1:1 propensity matching, 122 patients remained, with 61 in each cohort. Results Patient age was 63.3 years vs. 61.5 years, p = 0.36, in the transaxillary and sternotomy cohorts. Clinical baselines were well balanced between cohorts. Minimally invasive multivalve operations comprised n = 3 (4.9%) vs. n = 8 (13.9%), p = 0.21. The distribution of aortic ( n = 42, 68.9% vs. n = 44, 72.1%, p = 0.84) and mitral valve surgery ( n = 23, 37.7% vs. n = 27, 44.3%, p = 0.58) was similar. Except for intensive care unit stay (transaxillary 3.0 days vs. sternotomy 6.0 days, p < 0.01) and frequent renal failure in sternotomy patients, there were no significant differences in postoperative course. Transaxillary patients had comparable 30‐day (91.8% vs. 85.2%; p = 0.40) and long‐term survival at 3 years (89.1% vs. 73.9%; p = 0.052). Recurrent endocarditis rates did not differ ( n = 4, 6.6% vs. n = 5, 8.2%, p = 1.00). Conclusions In selected patients, minimally invasive surgery using the transaxillary access achieved comparable survival with full sternotomy without sacrificing procedural safety. A comprehensive diagnostic approach is essential to exclude patients needing extensive reconstructive surgery.
Петров et al. (2026) studied this question. Transaxillary minimally invasive valve surgery had similar 30-day survival (91.8% vs. 85.2%) and 3-year survival (89.1% vs. 73.9%) as sternotomy, with shorter ICU stay.